Predictors of visual outcome following management of traumatic cataract in open globe injuries

Session Details

Session Title: Cataract: Special Cases

Session Date/Time: Monday 15/09/2014 | 17:00-18:30

Paper Time: 17:56

Venue: Boulevard B

First Author: : S.Chatterjee INDIA

Co Author(s): :    D. Agrawal   N. Gupta   S. Malhotra        

Abstract Details

Purpose:

The issues in management of traumatic cataract in the setting of open globe injuries include restoration of the integrity of the ocular coats, removal of the damaged lens and visual rehabilitation with intra-ocular lens or contact lenses, simultaneous control of inflammation and prevention of infection and ocular hypertension. This study reports the visual outcome following management of traumatic cataract in patients with open globe injuries and identify the predictors of final visual outcome.

Setting:

Cornea & Anterior Segment Services, MGM Eye Institute Raipur, India

Methods:

The medical records of 83 patients with traumatic cataract resulting from open globe injuries were retrospectively reviewed. Patients with co-existent endophthalmitis, already sutured corneal tear or incomplete data were excluded. All patients underwent primary repair of the wound. The decision for removal of the cataract was left to the discretion of the surgeon. The cataract surgery was performed at a later date (secondary cataract surgery) if the wound was large and visibility obscured due to corneal edema, non- dilating pupil, iris prolapse or hyphema. In selected cases (small corneal laceration and good intra-operative visibility), it was removed at the time of corneal repair (primary cataract surgery). Intra-ocular lens was implanted if adequate capsular support was available. Pars plana lensectomy was performed if lens matter was in vitreous cavity. Main outcome measure was best corrected logMAR visual acuity. Good outcome was BCVA equal or better than 20/40 and poor outcome was BCVA less than 20/40. Univariate analysis was done by constructing a 2x2 table to test for level of significance with Fisher’s exact test. Those variables which reached statistical significance (p<0.05) in the univariate analysis was put into a multiple logistic regression model to identify independent risk factors.

Results:

Of the 83 patients enrolled, outcome data was analyzed in 65 eyes of 65 patients as 18 patients were excluded due to presence of endophthalmitis (11), incomplete follow-up (6) and inability to record visual acuity (1). There were 54(83.08%) males and 11(16.92%) females between the age of 5 to 56 years (mean: 23.05 ± 13.93 years). The presenting visual acuity ranged from perception of light to 20/160. The cataract was removed by phacoemulsification in 8(12%) patients, Simcoe-aspiration in 39 (60%) and automated vitreous cutter through pars plana in 18(28%) patients. Intra-ocular lens could not be implanted in 23 (33%) patients. Post-operative BCVA (spectacle or contact lens) was ≥ 20/40 in 37(56.92%), 20/50-20/200 in 19 (29.23%) and <20/200 in 9 (13.85%) patients. In univariate analysis primary cataract surgery (p=0.01) was associated with good outcome while corneal tear in the visual axis (p=0.01) and posterior segment complications (p=0.02) were associated with poor visual outcome. Multivariate analysis identified corneal tear involving the visual axis (p=0.018) and posterior segment complications (p=0.019) as statistically significant independent risk factors which were associated with poor outcome.

Conclusions:

Visual outcome after management of traumatic cataract in the setting of open globe injury in this series was not poor. It appears that it is always not necessary to remove the cataract during primary repair of the corneal wound. Predictors of poor visual outcome were corneal tear involving the visual axis and posterior segment complications.

Financial Interest:

NONE